Ambitious targets to disseminate best practice and improve access to care, alongside measurable parameters to determine progress, are essential if the substantial disparities in cancer outcomes between different regions and countries in Europe are to be closed up, conclude leading experts.
In a special session here at the European Society for Medical Oncology (ESMO) Congress 2016, a panel of leading oncologists and patient advocates held a debate with an audience of representatives of organizations from across the world to find solutions to the problem of cancer outcome disparities.
Although it was underlined that disparities in European cancer incidence and mortality are the result of a series of differences across the spectrum of cancer care and management, measures can be taken to help reduce the gaps between countries and save hundreds of thousands of lives.
Session co-chair, Ian Banks, MD, president of the European Men’s Health Forum, Brussels, Belgium, and visiting professor in men’s health, University of Ulster, United Kingdom, told Medscape Medical News that this requires translating European-level recommendations down to the local level.
He said, “You can have overarching guidelines and so on, but you invariably have to modify them for a local environment in which you are working. A good example would be trying to compare the delivery of services in the UK, for example, with Turkey. They are completely different systems, so therefore the guidelines would not fit everything.”
He pointed out, however, that “there are certain overarching issues that are common to all people in all parts of the world, let alone just in Europe, and those are the areas that are particularly of concern because that’s where the disparities really are bad.”
In an interview, Dr Banks said that, in a lot of cases, improving standards across Europe and eliminating disparities in cancer care are not just a case of having access to the latest and most expensive treatments.
He said that one element that has been missed, including by the European Cancer Concord in its recent publication, is primary care, “and yet that is a very cost-effective side of medicine.”
He added: “An awful lot of the treatment and management can take place in the community, and we know that patients like that and we know that especially if it means that they can go back to work. That is particularly important in Europe.”
“Not everything is about money. Some of it is about the mindset and how we actually use the existing services,” he said.
Ana-Maria Forsea, MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, opened the session by setting out what is known so far about cancer disparities in Europe.
She noted that although the average fatality rate for cancer across Europe of 0.47 is high, there are major differences in the incidence and mortality of all cancers across the continent and that a North–South, West–East gradient is seen in all statistics.
Survival differences are also seen across cancers, with, in some cases, the difference between the best-faring country and the worst-faring country in terms of survival almost 50%. This relevance of this was underlined by a recent analysis of World Health Organization data, reported on by Medscape Medical News, which showed that cancer is now responsible for more deaths than cardiovascular disease in 12 European countries.
Dr Forsea explained that cancer outcome disparities result from “a huge mountain of outcomes that are visible,” including incidence, mortality, survival, and overall burden. “However, beneath these visible differences in outcomes are disparities across the whole spectrum of cancer care,” she added.
This includes disparities in prevention and screening, diagnosis, and the availability of drugs and treatments and of multidisciplinary care, alongside disparities in survivorship care and cancer registration and reporting. These are underpinned by disparities in healthcare resources and management.
Taking, for example, the availability of drugs, there are huge disparities in the access to innovative drugs. As reported by Medscape Medical News, a survey of 30 European countries presented at ESMO 2016 showed that more than 5000 patients across Europe do not have access to the latest drugs for metastatic melanoma, including agents targeting BRAF mutations and novel immunotherapeutics, and that there is a huge disparity between Western and Eastern Europe.
However, there are also large disparities in access to what are termed “essential” anticancer drugs, with a recent survey revealing stark differences across Europe in the availability and out-of-pocket costs of anticancer drugs for the treatment of common cancers, such as lung cancer, colorectal cancer, and metastatic breast cancer.
These issues are driven by large differences in average annual net earnings across Europe and are reflected in differences in total health expenditure per capita, which is correlated to the cancer incidence/mortality ratio.
Dr Forsea said that although the availability of resources is one of the most important drivers of differences in cancer survival between countries, it does not explain the whole picture because governance and access to care also play a huge part.
She noted that many recently published recommendations, guidelines, and policy papers set out best practice and good-quality care at the European level. However, “their implementation is the business of each member state,” she pointed out, which “relies on self-reporting.”
Dr Forsea concluded that action on the implementation of guidelines requires the measurement of progress via measurable parameters, which will, in turn, allow the objective assessment. This, she said, can be achieved only with long-term planning and investment and the right tools.
